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Cancer
 
Kidney (Renal) Cancer

The Cancer Monthly database currently has the clinical results (survival, side effects, and more) for 38 recent kidney cancer therapies including hormone therapy, biological therapy, immunotherapy, and chemotherapy.

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Introduction

Renal cell carcinomas account for 90 to 95% of malignant neoplasms arising from the kidney. The annual incidence of renal cell carcinomas continues to rise and now includes nearly 36,000 cases annually in the U.S. resulting in 12,500 deaths. The male to female ratio is 2:1. This cancer can be diagnosed at any age, but the incidence peaks between the ages of 50 and 70.

Notable features include resistance to chemotherapy, infrequent but occasional responses to biological therapies such as interferon alpha and interleukin 2 and anecdotal reports of spontaneous regressions.

The symptoms include hematuria, abdominal pain, and a flank or abdominal mass. Other symptoms are fever, weight loss, anemia, and a varicocele. The standard evaluation of patients with suspected renal cell tumors includes a CT scan of the abdomen and pelvis, a chest radiograph, urine analysis, and urine cytology.

Staging and Prognosis

Two staging symptoms commonly used are the Robson classification and the American Joint Committee on Cancer (AJCC) staging system. The following table is taken from the Robson classification system. The prognosis generally depends on stage and there are four main stages (I to IV):

Stage
Description
5-year Survival
I
Confined to the kidney
66%
II
Extend through the renal capsule, but confined to Gerota's fascia
64%
IIIA
Involve the renal vein or vena cava
64%
IIIB
Involve the hilar lymph nodes
20%
IV
Includes tumors that are locally invasive to adjacent organs (excluding the adrenal glands), or distant metastases
11%

Treatment

Localized Tumors - The standard management for stage I or II tumors and selected cases of stage III disease is radical nephrectomy.

Advanced Disease - Investigational therapy is the first-line treatment for metastatic disease as no immune approach or chemotherapy agent has shown significant anti-tumor activity. The prognosis is highly variable. Surgery has a limited role for patients with metastatic disease. One indication for nephrectomy is to alleviate pain or hemorrhage from a primary tumor.

Interferon alpha and interleukin-2 produce regressions in 10 to 20% of patients but these are rarely durable.

Treatment Results

The Cancer Monthly database currently has the clinical results (survival, side effects, and more) for 38 recent kidney cancer therapies including hormone therapy, biological therapy, immunotherapy, and chemotherapy.

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Source: Howard I. Scher, Robert J. Motzer, Bladder and Renal Cell Carcinomas, in HARRISON'S PRINCIPLES OF INTERNAL MEDICINE, pt. 5 § 80, at 539-543 (Dennis L. Kasper, M.D. et al., eds, 16th ed 2005).